Basic Information
| Provider Information | |||||||||
| NPI: | 1164863775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEILE | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | LENN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APRN FNP BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 SWAN LN | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636407679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734312588 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 108 FRIZZELL ST | ||||||||
| Address2: | |||||||||
| City: | POTOSI | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636641505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734388500 | ||||||||
| FaxNumber: | 5734388787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2013 | ||||||||
| LastUpdateDate: | 03/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2013024404 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.